title: Clinical and immunological implications of increase in CD208+ dendritic cells in tonsils of patients with immunoglobulin A nephropathy.
abstract: BACKGROUND
  The therapeutic effect of tonsillectomy for immunoglobulin A nephropathy (IgAN) has been widely recognized, but the mechanism by which tonsillar immunity leads to glomerulonephritis has been unclear. We investigated subtypes and localization of dendritic cells (DCs) in tonsils and looked for relationships between the tonsillar DCs and the clinical features and renal histological changes of patients with IgAN.
  
  
  METHODS
  We examined tonsils from 33 IgAN patients, using as control tonsillar specimens from subjects without glomerulonephritis. Five distinct markers of DCs (CD303, CD1c, CD209, CD208 and CD1a) were analyzed by immunohistochemistry and flow cytometry. The mRNA levels of these DC markers were evaluated using real-time polymerase chain reaction. The clinical data and histological results obtained evaluating renal biopsy tissues were statistically compared with immunological data.
  
  
  RESULTS
  Of the five subtypes of DCs, CD208(+) DCs were significantly increased in the tonsils of IgAN patients compared with that of controls. Furthermore, the number of CD208(+) DCs in the tonsils was positively and linearly correlated with the proportion of crescentic glomeruli in renal biopsy tissues and with the urinary protein level. Only few CD208(+) cells, however, were found in the kidney biopsy specimens of IgAN patients.
  
  
  CONCLUSIONS
  These observations suggest that increased CD208(+) DCs in tonsils may play a directive role in the pathogenesis of IgAN. The present results support the therapeutic significance of tonsillectomy for IgAN patients.
authors.affiliation: Department of Nephrology and Endocrinology, National Defense Medical College, Tokorozawa, Saitama, Japan.
authors.forename: Hanako
authors.initials: H
authors.lastname: Takechi
authors.forename: Takashi
authors.initials: T
authors.lastname: Oda
authors.forename: Osamu
authors.initials: O
authors.lastname: Hotta
authors.forename: Kojiro
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Naoki
authors.initials: N
authors.lastname: Oshima
authors.forename: Takeshi
authors.initials: T
authors.lastname: Matsunobu
authors.forename: Akihiro
authors.initials: A
authors.lastname: Shiotani
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nagura
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Shimazaki
authors.forename: Seiichi
authors.initials: S
authors.lastname: Tamai
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Sakurai
authors.forename: Hiroo
authors.initials: H
authors.lastname: Kumagai
mesh_terms: D000328:Adult; D015153:Blotting, Western; D016022:Case-Control Studies; D003713:Dendritic Cells / Q000276:immunology* / Q000378:metabolism / Q000473:pathology; D005260:Female; D005434:Flow Cytometry; D005922:Glomerulonephritis, IGA / Q000276:immunology* / Q000378:metabolism / Q000601:surgery; D006801:Humans; D007124:Immunoenzyme Techniques; D007668:Kidney / Q000276:immunology / Q000378:metabolism / Q000473:pathology; D051907:Lysosomal Membrane Proteins / Q000378:metabolism*; D008297:Male; D009363:Neoplasm Proteins / Q000378:metabolism*; D014066:Palatine Tonsil / Q000276:immunology* / Q000378:metabolism / Q000473:pathology; D012333:RNA, Messenger / Q000235:genetics; D060888:Real-Time Polymerase Chain Reaction; D020133:Reverse Transcriptase Polymerase Chain Reaction; D014068:Tonsillectomy; D059666:Lysosomal-Associated Membrane Protein 3
chemical_list: D051907:Lysosomal Membrane Proteins; D009363:Neoplasm Proteins; D012333:RNA, Messenger; C114233:LAMP3 protein, human; D059666:Lysosomal-Associated Membrane Protein 3
keywords: CD208; IgA nephropathy; dendritic cells; glomerular crescent; tonsillectomy